HomeMy WebLinkAbout3235 MOORE LN - APPLICATIONS - 10/10/2011Oct 10 11 10:12a Swan Heating and Air 9706130826 p.2
CityPlanning; Deve nt & Tranuporbftn
C®U' nS Fort CoNns, CO 80524.0. Box �o
F&t
Phone 970416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application Is to be used to apply forthe following petards only (check all that apply). D Air Conditioning
13 n (Merior norm-strucbun* D Electrical Alteration (not service change) D Gas Lighter D Gas Log
1WHeating knit D Lawn Spr"mrlder ❑ Mobile dome replacement D Roofing II Sewer Line D Photo-voitaic
D Ventilation D Water Heater D Water Une D Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications wig not be accepted.
Application #T_ Date
fir offliv rw asrdy
lob Site Addr ew (avz&m9
Value of Coo ruction (tabor, mal a rlaL% Profit)
Property Owner Name
Address
City/Stabe Zip
Phone CI - G
Lo
�a1-L`S��
Applicant Name
Address
QylState Zip
Phone
Conbadi r
Address
Gty/State Zip
Phone 9- 7 o
r� i ?� t
w• �1 h S 1' ()5
2 l 70
Contractor City of Ft Colgri Sales Tax #
Are you paying tames here or by report? D Hie RePOrt
S�iisawnrmi6t &IeWLTdbyagca tracbm
Are you paying with your trust account? EMs
13 No
is this a residential or corroperclal project? ffitesidential D Commerctal
if residential, is it: le Farrifly Detached ❑ Comdo/bwnhorrw (single family attached) ❑ Duplex
D MuftiifamOY (apartment) O Garage
if mmmedat is it ❑ Bank D Bar D Church O HOWMDtd D Me ical office ❑ Office D R+ afi
D Restaurant ❑ Other (explain
Ls tits braiding 50 years of age or mae? ❑ Yes o If)'Es. YW xaYneed ib con&KfA&U* PraWva&n
If this is for a de dWm permit, what year was the building c strud 8cP
ypnw W 1975, you worneed an asbe%075 asseowlOnrW5ubJy& wrp, eds appAwroft.
1-a ■ rn• r a
*ff Fawn spmtmd lwjbaddfowMmuftr, must flat licensed plumber. If rusifinie A/C, must list licensed elecbidan-
Suboondacimm List'iireM7WnYnarneorOIYOfRtdh'IN'tWM'
Hectrtaarm -
Plumber Wdlard>af Roofer Other
I hereby advrowiedge that I have read this appikation and state that the above Information is wmpkte and correct I agree to
oanply "a all regnhements contained herein and aty ordinances and state iarers regulating butidtn9 construction. I Imow that a
permit is not valid until it has been Paid and issued.
ApplIGIMIM Perot Ntane'
(�i 1C-, rv�,e ��gmmature� i t In '�i r" oa1,e 1 l L Z G l 1